Prostate Enlargement

Prostate EnlargementProstate enlargement is known as BPH (benign prostatic hyperplasia).  This simply means that the cells of the prostate gland have increased in size and urination becomes difficult with frequency, urgency, getting up at night, difficulty emptying, and occasionally blood.

BPH occurs as the gland enlarges and begin to constrict the urethra.  The noncancerous cells begin to grow as men age and some men will notice symptoms in their 40’s and 50’s.

Symptoms usually start gradually and can include weak urinary stream, trouble starting the flow of urine, stopping and starting, incomplete emptying, urinating at night, sudden urges to urinate, leaking or dribbling after urinating, and straining to urinate.

Detection is usually based on the degree of severity of the symptoms.  Once the patient is referred to or sees a urologist, several tests are performed.  First a careful history and physical exam is performed including a digital prostate exam.  Urinalysis is performed to look for blood , infection, or cancer.  We then perform a cystscopy which is a fiberoptic scope that is passed into the urethra.  Careful inspection of the prostate gland and bladder is then performed.  Another test is the uroflow and post void residual.  Patients report to the office with a full bladder and are asked to void into a special machine.  This uroflow machine can measure the volume of urine, force of urine, and then the residual is measured with a bladder scanner.

If the symptoms are mild, most men choose not to be treated.  However, if the symptoms are bothersome, men can choose from medications, office procedures, and surgical procedures to manage their BPH symptoms.

There are many supplements that men can take such as saw palmetto, herbal extracts which can help.

Medications include alpha blockers (tamsulosin, rapaflo) which help relax the prostate muscles to improve urine flow.

5-alpha reductase inhibitors such as finasteride and dutasteride block a hormone related to testosterone and can shrink the prostate gland.

Nonsurgical options include two office procedures which are performed in the office.

1. Cooled thermotherapy (CTT);
This is a 30 minute procedure which is performed through a special catheter.

2. Transurethral needle ablation (Prostiva);  This is a shorter procedure which is performed with a special probe that is inserted into the urethra and radiofrequency energy is employed.

Surgical procedures includes the traditional transurethral resection of the prostate (TURP), greenlight laser photovaporization (PVP), and the plasma button procedure.

It is important to urinate when the urge is present and not to delay until the bladder is full.  Eating healthy
is also very important.  It is essential to avoid alcohol and caffeine at night.  Certain medications especially antihistamines can tighten the muscles and make urination more difficult.

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